In this trial 133 patients fulfilled the inclusion criteria and h

In this trial 133 patients fulfilled the inclusion criteria and had a minimum followup of more than 15 years.

Results: Cancer specific survival was 81.9%, 79.5% and 76.7%, and progression-free survival with bladder preservation was 75.5%, 64.9% and 57.8% at 5, 10 and 15 years, respectively. Patient age had a negative impact on overall survival on univariate NVP-BSK805 mw (HR 0.842, p = 0.049) and multivariate analyses (HR

1.062, p = 0.000), and according to median and quartile age stratifications (p = 0.000 and p = 0.000, respectively). However, age did not have a negative impact on cancer specific survival even when following the same stratifications. Although progression and recurrence were concentrated during the first 3 years (70% and 65%, respectively), both steadily increased afterward. A followup schedule was developed according to this sequence of events.

Conclusions: Radical transurethral bladder tumor resection is a reliable therapeutic approach for patients with muscle invasive bladder cancer after complete tumor resection and with negative biopsies of the tumor bed. These results are consistent in all age ranges.”
“Purpose:

Studies suggest lowering the threshold of the prostate specific antigen test in obese men due to the hemodilution effect but prostate specific antigen may be affected by prostate volume and insulin resistance, which also increase with obesity.

Thus, we examined the combined effect of these factors on prostate specific antigen.

Materials MK-4827 and Methods: We analyzed 3,461 Korean men 30 to 80 years old with prostate volume data available who underwent routine evaluation. We examined the effect of plasma volume, homeostatic model assessment index, prostate volume and body mass index on prostate specific antigen, and prostate specific antigen 4EGI-1 datasheet mass and mass ratio (total circulating prostate specific antigen protein per prostate volume) by the trend test and/or ANOVA after adjusting for age and/or prostate volume.

Results: Body mass index had positive associations with plasma volume, the homeostatic model assessment index and prostate volume (p for trend <0.01). Prostate specific antigen had a positive association with prostate volume and a negative association with plasma volume (p for trend <0.01) but not with homeostatic model assessment index. The adjusted R-2 of prostate volume vs prostate specific antigen was greater than for plasma volume vs prostate specific antigen while for body mass index vs prostate volume it was less than for body mass index vs plasma volume (0.0892, 0.0235, 0.1346 and 0.3360, respectively). Prostate specific antigen mass was not associated with plasma volume or body mass index but it was still associated with prostate volume after adjusting for plasma volume or body mass index (p for trend <0.01).

A randomized trial is needed <p id=”"p003″”>To the Editor:

A randomized trial is needed. <p id=”"p003″”>To the Editor: Cytomegalovirus (CMV) DNA and proteins are expressed in several types of human cancers and metastases(1)

but not in healthy surrounding tissues, suggesting a possible role for the virus in the cancer.(2) The malignant GSK690693 clinical trial brain tumor glioblastoma has a dismal prognosis, with a median overall survival of 12 to 14 months and a 2-year survival of 15 to 26%. We examined more than 250 cases of glioblastoma (Fig. S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). Of these patients, only 1 was CMV-negative. Of the 75 patients we evaluated, the median rate …”
“Background Refractory chronic cough causes substantial symptoms and quality-of-life impairment. Similarities between central reflex sensitisation in refractory chronic cough and neuropathic pain suggest that neuromodulators such as gabapentin might be effective for refractory chronic cough. We established the efficacy of gabapentin in patients with refractory chronic cough.

Methods This randomised, double-blind, placebo-controlled trial was undertaken at an outpatient clinic in Australia. Adults with refractory chronic cough (>8 weeks’ duration) without active respiratory disease or infection were randomly assigned to receive gabapentin (maximum tolerable daily dose of 1800 mg) or matching 5-Fluoracil placebo for 10 weeks. Block randomisation was

done with randomisation generator software, stratified by sex. Patients and investigators were masked to assigned treatment. The primary endpoint was change APR-246 in cough-specific quality of life (Leicester cough questionnaire [LCQ] score) from baseline to 8 weeks of treatment, analysed by intention

to treat. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12608000248369.

Findings 62 patients were randomly assigned to gabepentin (n=32) or placebo (n=30) and ten patients withdrew before the study end. Gabapentin significantly improved cough-specific quality of life compared with placebo (between-group difference in LCQ score during treatment period 1.80, 95% CI 0.56-3.04; p=0.004; number needed to treat of 3.58). Side-effects occurred in ten patients (31%) given gabapentin (the most common being nausea and fatigue) and three (10%) given placebo.

Interpretation The treatment of refractory chronic cough with gabapentin is both effective and well tolerated. These positive effects suggest that central reflex sensitisation is a relevant mechanism in refractory chronic cough.”
“The aim of this study was to estimate the prevalence of compulsive buying and its association with sociodemographic characteristics and depressive symptoms in a nationally representative sample of the German population using the validated German version of the Compulsive Buying Scale (CBS; Faber and O’Guinn, 1992) in order to have a direct comparison with U.S. findings.

ALDH2 mediates both the detoxification of reactive aldehydes such

ALDH2 mediates both the detoxification of reactive aldehydes such as acetaldehyde and 4-hydroxy-2-nonenal

and the bioactivation of nitroglycerin to nitric oxide. In addition, chronic nitrate treatment results in ALDH2 inhibition and contributes to nitrate tolerance. Our laboratory recently identified ALDH2 to be a key mediator of endogenous cytoprotection. We reported that ALDH2 is phosphorylated and activated by the survival kinase protein kinase C epsilon and found a strong inverse correlation between ALDH2 activity and infarct size. We also identified a small molecule ALDH2 activator which reduces myocardial infarct size induced by ischemia/reperfusion in vivo. In this review, we discuss evidence that ALDH2 is a key mediator of endogenous survival signaling in the heart, suggest possible cardioprotective mechanisms mediated by ALDH2 and Tanespimycin nmr discuss potential clinical implications of these findings. (Trends

Cardiovasc Med 2009;19:158-164) (C) 2009, Elsevier Inc.”
“Early maternal deprivation (MD), 24 h of dam-litter separation on postnatal day (PND) 9, has been proposed as a suitable animal model to investigate some neuropsychiatric disorders with a base in neurodevelopment that also compromises metabolic and endocrine homeostasis. Atypical antipsychotics are frequently prescribed to children and adolescents as first-line treatment for several mental disorders despite the adverse metabolic effects frequently reported. However, persistent long-term effects after adolescent Selleck Cilengitide drug therapy have been scarcely investigated. In the present study we aimed to investigate the long-lasting metabolic selleck compound and behavioral effects of MD in combination with the administration of an atypical antipsychotic, i.e. olanzapine, during adolescence.

For that purpose, male and female Wistar rats not exposed (control group, Co) and exposed to the MD protocol were administered with oral olanzapine (Olan, 7.5 mg/kg/day) or vehicle (Vh, 1 mM acetic acid) in drinking water from PND 28 to PND 49. Body weight

gain, glycaemia and plasma triglyceride (TG) levels were evaluated as relevant metabolic parameters. MD significantly diminished body weight gain, while Olan administration only induced a subtle decrease in body weight gain among female animals in the long-term. Olan discontinuation decreased plasma TG levels in adult rats, an effect that was counteracted by neonatal exposure to the MD protocol. Both MD and Olan treatment impaired cognitive function in the novel object recognition test, although no interaction between treatments was observed. Neither MD nor Olan administration affected psychotic-related symptoms evaluated in the prepulse inhibition task, although animals treated with Olan showed an increased reactivity to the first acoustic stimulus. MD diminished the corticosterone stress-induced response among females, and reduced the expression of CB1 receptors in the hippocampus of both male and female rats.

Both compounds produced a rapid and marked translocation of AhR i

Both compounds produced a rapid and marked translocation of AhR into the nucleus, induced the expression of the AhR target genes cytochrome P-450 1A1 (CYP1A1) and AhR repressor (AhRR), and inhibited proliferation of HaCaT cells. Among the G(1) phase cell cycle-related proteins, levels of the retinoblastoma protein (RB), which is known to interact with AhR, and levels of the cyclin dependent kinase (CDK) 6 were reduced by eugenol and isoeugenol, whereas steady-state levels of CDK2 and CDK4 remained unaffected. Protein NU7026 concentration levels of CDK inhibitor (CKI) p27(KIP1), known to be modulated in an AhR-dependent manner, were increased

after treatment with both substances. In conclusion, data show that the antiproliferative properties of eugenol and isoeugenol in HaCaT cells are mediated through AhR, and thereby the molecular mechanisms of action in these cells were identified for the first time in this study.”
“BACKGROUND: Recent studies from selected centers

have shown that early surgical treatment of aneurysms in subarachnoid hemorrhage (SAH) patients can improve outcomes. These results have not been validated in clinical practice at large.

OBJECTIVE: To identify factors and outcomes associated with timing of ruptured intracranial aneurysm obliteration treatment in patients with SAH after hospitalization LEE011 in vitro in the United States.

METHODS: We analyzed the data from the Nationwide Inpatient Sample (2005-2008) for all patients presenting with primary diagnosis of SAH, receiving aneurysm treatment (endovascular coil embolization or surgical clip placement). Early treatment was defined as aneurysm treatment performed within 48 hours and delayed treatment if treatment was performed after 48 hours of admission.

RESULTS: Of 32 048 patients with SAH who underwent aneurysm treatment, 24 085 (75.2%) underwent early treatment and 7963 (24.8%) underwent delayed treatment. Female sex (P = .002), endovascular click here embolization (P

< .001), and weekday admission (P < .001) were independent predictors of early treatment. In the early treatment group, patients were more likely discharged with none to minimal disability (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.14-1.47) and less likely to be discharged with moderate to severe disability (OR 0.77, 95% CI 0.67-0.87) compared with those in the delayed treatment group. The in-hospital mortality was higher in the early treatment group compared with the delayed treatment group (OR 1.36 95% CI 1.12-1.66).

CONCLUSION: Patients with SAH who undergo aneurysm treatment within 48 hours of hospital admission are more likely to be discharged with none to minimal disability. Early treatment is more likely to occur in those undergoing endovascular treatment and in patients admitted on weekdays.

Moreover, an anterograde neuronal tracer, biotinylated dextran am

Moreover, an anterograde neuronal tracer, biotinylated dextran amine (BDA). was demonstrated to pass from the neonatally LOT-transected bulb, through the transected retrobulbar site, towards the olfactory cortex, far caudally at a level

near the optic chiasm. The regenerated structures lacked immunoreactivity for myelin basic protein and electron-dense myelinated axon bundles, and were also characterized by the thinness of the BDA(+) terminal zone within the olfactory cortex and the lack of its caudal extension. Young adult rats subjected to unilateral bulbectomy contralateral to the neonatally LOT-transected side showed perfect ability to discriminate cycloheximide solution by olfaction. From these findings, we conclude that the spontaneously selleck compound regenerated olfactory system is functional despite structural incompleteness (C) 2010 Elsevier Ireland Ltd and the Japan Neuroscience Society All rights reserved”
“Adeno-associated virus (AAV) has previously been shown to inhibit the replication of its helper virus herpes simplex virus type 1 (HSV-1), and the inhibitory activity has been attributed to the expression of the AAV Rep proteins. In the present study, we assessed the Rep activities required for inhibition of HSV-1 replication using

Selinexor mouse a panel of wild-type and mutant Rep proteins lacking defined domains and activities. We found that the inhibition of HSV-1 replication required Rep DNA-binding and ATPase/helicase activities but not endonuclease activity. The Rep activities required for inhibition of HSV-1 replication precisely coincided with the activities that were responsible for induction of cellular DNA

damage and apoptosis, suggesting that these three processes are closely linked. Notably, Silmitasertib in vitro the presence of Rep induced the hyperphosphorylation of a DNA damage marker, replication protein A (RPA), which has been reported not to be normally hyperphosphorylated during HSV-1 infection and to be sequestered away from HSV-1 replication compartments during infection. Finally, we demonstrate that the execution of apoptosis is not required for inhibition of HSV-1 replication and that the hyperphosphorylation of RPA per se is not inhibitory for HSV-1 replication, suggesting that these two processes are not directly responsible for the inhibition of HSV-1 replication by Rep.”
“Sex differences in song nuclei are evident across songbirds. To explore candidate genes involving in the sexual dimorphism of song nuclei, the present study used suppression subtraction hybridization to identify male-biased genes in the Bengalese finch (Lonchura striata) From 199 clones with an inserted sequence, we obtained a gene (parvalbumin.

Future research should focus on the mechanisms linking parental d

Future research should focus on the mechanisms linking parental divorce and suicidal ideation. (C) 2010 Elsevier Ireland Ltd. All rights reserved.”
“Sexual obsessions are a common symptom of obsessive-compulsive disorder (OCD) that may be particularly troubling to patients.

However, little research has examined concerns surrounding sexual 4SC-202 ic50 orientation, which includes obsessive doubt about one’s sexual orientation, fears of becoming homosexual, or fears that others might think one is homosexual. The present study reports rates and related characteristics of individuals with sexual orientation obsessions in a clinical sample. Participants from the DSM-IV Field Trial (n = 409; Foa et al., 1995) were assessed with the Yale-Brown Obsessive Compulsive Symptom Checklist and Severity Scale (YBOCS). We found that 8% (n = 33) reported current sexual orientation obsessions and 11.9% (n = 49) endorsed lifetime symptoms. Patents with a history of sexual orientation obsessions

were twice as likely to be male than female, with moderate https://www.selleckchem.com/products/epz004777.html OCD severity. Time, interference, and distress items from the YBOCS obsessions subscale were significantly and positively correlated with a history of obsessions about sexual orientation. Avoidance was positively correlated at a trend level (p=0.055). Obsessions about sexual orientation may be associated with increased distress, interference, and avoidance, which may have unique clinical implications. Considerations for diagnosis and treatment are discussed. (C) 2010 Elsevier Ireland Ltd. All rights reserved.”
“Background. Studies concerning the effect of different types of leisure activities on various cognitive domains are limited. This study tests the hypothesis that mental,

physical, and social activities have a domain-specific protection against cognitive decline.

Methods. A cohort of a geographically defined population in China was examined in 2003-2005 and followed for an average of 2.4 years. Leisure activities were assessed in 1,463 adults aged 65 years GSK923295 price and older without cognitive or physical impairment at baseline, and their cognitive performances were tested at baseline and follow-up examinations.

Results. High level of mental activity was related to less decline in global cognition (beta = -.23, p < .01), language (beta = -.11, p < .05), and executive function (beta = -.13, p < .05) in ANCOVA models adjusting for age, gender, education, history of stroke, body mass index, Apolipoprotein E genotype, and baseline cognition. High level of physical activity was related to less decline in episodic memory (beta = -.08, p < .05) and language (beta = -.15, p < .01). High level of social activity was associated with less decline in global cognition (beta = -.11, p < .05).

73 m(2) Study B will compare inhibitor-blocker treatment to the

73 m(2). Study B will compare inhibitor-blocker treatment to the inhibitor alone in 486 late-stage patients with eGFR 25-60 ml/min per 1.73 m(2).

We used correlation and multiple regression cross-sectional analyses to determine associations of baseline parameters with total kidney, liver, or liver cyst volumes measured by MRI in Study A and eGFR in both studies. Lower eGFR and higher natural log-transformed urine albumin excretion were independently associated with a larger R788 order natural log-transformed total kidney volume adjusted for height (ln(HtTKV)). Higher body surface area was independently associated with a higher ln(HtTKV) and lower eGFR. Men had larger height-adjusted total kidney volume and smaller liver cyst volumes than women. A weak correlation was found between the ln(HtTKV) and natural log-transformed total liver volume adjusted for height or natural log liver cyst volume in women only. Women had higher urine aldosterone excretion and lower plasma potassium. Thus,

our analysis (1) confirms a strong association between renal volume and functional parameters, (2) shows that gender and other factors differentially affect the development of polycystic disease in the kidney and liver, and (3) suggests an association between anthropomorphic measures reflecting prenatal and/or postnatal growth and disease severity. Kidney International (2012) 81, 577-585; doi: 10.1038/ki.2011.411; published online 28 December 2011″
“Animals exposed to phencyclidine (PCP) during the neonatal selleckchem period have fewer GABAergic interneurons in the corticolimbic area, including the hippocampus, and exhibit abnormal behaviors after attaining maturation Sonidegib supplier that correspond with schizophrenic symptoms. Since a lack of inhibitory interneurons in the hippocampus has also been reported in postmortem studies of patients with schizophrenia, the deficit may induce abnormal activity of hippocampal neurons that underlies

pathological states in schizophrenia. However, it remains unclear how PCP treatment during the neonatal period affects the discharge activity of hippocampal neurons in adulthood. In the current study, single unit responses of hippocampal CA3 neurons to paired auditory clicks were recorded in freely moving mice repeatedly injected with PCP or saline during the neonatal period. The recorded neurons were classified into two subpopulations, narrow-spike neurons and broad-spike neurons, based on the spike width. The spontaneous discharge rate was higher in the narrow-spike neurons than in the broad-spike neurons, indicating that the narrow-spike neurons correspond with hippocampal inhibitory neurons. The proportion of narrow-spike neurons was significantly smaller in neonatally PCP-treated mice than in saline-treated mice.

2%) or bleeding (10 2%) complications, pulmonary reperfusion edem

2%) or bleeding (10.2%) complications, pulmonary reperfusion edema (9.6%), pericardial effusion (8.3%), need for extracorporeal membrane oxygenation (3.1%), and in-hospital mortality due to perioperative complications (4.7%). Documented 1-year mortality was 7%. Preoperative exercise capacity was predictive of 1-year mortality. Postoperative pulmonary vascular resistance predicted in-hospital and 1-year

mortality. In patients evaluated within 1 year after surgery, the median pulmonary vascular resistance had decreased from 698 to 235 dyn.s.cm(-5) (95% confidence limit, 640-874 and 211-255, respectively, n – 70) and the median 6-minute walk MRT67307 distance had increased from 362 to 459 m (95% confidence limit, 340-399 and 440-473, respectively, n – 168). New York Heart Association functional class improved with most patients progressing from class III/IV to class I/II.

Conclusions: Pulmonary endarterectomy is associated with a low in-hospital mortality rate and improvements in hemodynamics and exercise capacity. (J Thorac Cardiovasc Surg 2011;141:702-10)”
“Brain ischemia is often a consequence of cardiac or neurologic surgery. Prophylactic pharmacological LY2109761 purchase neuroprotection would be beneficial for patients undergoing surgery to reduce brain damage due to ischemia. We examined the effects of two antiarrhythmic doses of lidocaine (2

or 4 mg/kg) on rats in a model of transient global cerebral ischemia. The occlusion of both common carotid arteries combined with hypotension for 10 min induced neuronal loss in the CA1 region of the hippocampus (18 +/- 12 vs. 31 +/- 4 neurons/200 mu m linear distance of the cell body layer, X +/- SD; P<0.01). Lidocaine (4 mg/kg) 30 min before, during and 60 min after ischemia increased dorsal hippocampal CA1 neuronal survival 4 weeks after global cerebral ischemia

(30 +/- 9 vs. 18 +/- 12 neurons/200 mu m; P<0.01). There was no significant cell loss after 10 min of ischemia in the CA3 region, the dentate region or the amygdalae; these regions were less sensitive than the CA1 region to ischemic damage. Lidocaine not only increased hippocampal CA1 neuronal survival, but also preserved cognitive function associated with the CA1 region. Using secondly an active place avoidance task, there were fewer entrances into an avoidance zone, defined by relevant distal room-bound cues, in the lidocaine groups. The untreated ischemic group had an average, over the nine sessions, of 21 +/- 12 (X +/- SD) entrances into the avoidance zone per session; the 4 mg/kg lidocaine group had 7 +/- 8 entrances (P<0.05 vs. untreated ischemic) and the non-ischemic control group 7 +/- 5 entrances (P<0.01 vs. untreated ischemic). Thus, a clinical antiarrhythmic dose of lidocaine increased the number of surviving CA1 pyramidal neurons and preserved cognitive function; this indicates that lidocaine is a good candidate for clinical brain protection. (C) 2011 IBRO. Published by Elsevier Ltd. All rights reserved.

The other 799 (61 2%) underwent thoracotomy: 767 underwent resect

The other 799 (61.2%) underwent thoracotomy: 767 underwent resection, but 32 (2.5%) had an exploratory thoracotomy. Thoracoscopy had suggested unresectability in 7 (0.5%) patients, had been incompletely carried out in 4 (0.3%), and was unfeasible in 21 (1.6%) owing to insurmountable technical reasons. In our previous series from 1980 to 1991 the exploratory thoracotomy rate had been 11.6%. In

Idasanutlin in vivo the present series, after the introduction of routine thoracoscopy in the staging process, the exploratory thoracotomy rate was 2.5%. Thoracoscopy was reliable in excluding unresectability (negative predictive value 0.97). The global percentage of correct staging was significantly better (P < .0001) by thoracoscopy (73.3%) than by computed buy Talazoparib tomography (48.7%). Considering T descriptor, video-assisted thoracic surgery correctly matched with final pathologic staging in 96.2% of patients.

Conclusions: Routine preliminary videothoracoscopy ensured assessment of tumor resectability and feasibility of the resection through thoracoscopy and limited unnecessary thoracotomies.”
“Targets presented outside the focus of attention trigger stimulus-driven spatial reorienting and activation of the right temporal-parietal junction (rTPJ). However, event-related functional resonance imaging (fMRI) studies

that used task-irrelevant non-predictive cues systematically failed to activate rTPJ, suggesting that this region controls reorienting

only when attention is shifted between two task-relevant locations. Here we challenge this view showing that non-predictive peripheral cues can affect activity in rTPJ, but only when they share a feature with the target: i.e. when they are set-relevant. Trials including a set-relevant cue plus a target on the uncued/unattended side produced the slowest reaction times and selective activation of the rTPJ. These findings demonstrate that rTPJ is not involved only in reorienting between two task-relevant locations, but engages also when non-predictive cues are set-relevant, thereby, irrespective of voluntary attention and breaches of task-related expectations. (C) 2009 Elsevier Ltd. All rights reserved.”
“Objective: This Prexasertib purchase study investigates the cardioprotective role and mechanism of action of urocortin in patients undergoing cardiac surgery, with respect to protein kinase C epsilon expression, activation, and relocation.

Background: Cardioplegic arrest and subsequent reperfusion inevitably expose the heart to iatrogenic ischemia/reperfusion injury. We previously reported that iatrogenic ischemia/reperfusion injury caused myocyte induction of urocortin, an endogenous cardioprotective peptide.

Methods: Two sequential biopsies were obtained from the right atrium of 25 patients undergoing coronary artery bypass grafting at the start of grafting (internal control) and 10 minutes after release of the aortic clamp.

Assessments were performed prior to and at 1, 3, 6, and 12 months

Assessments were performed prior to and at 1, 3, 6, and 12 months following intervention (angioplasty and/or supervised exercise program). Clinical indicators of lower limb ischemia Raf inhibitor (treadmill walking distances,

ankle pressures), generic (SF36, EuroQol), and disease-specific (Kings College VascuQol) quality of life questionnaires were analyzed. Correlation analysis was performed for index scores (SF-6D, EQ-5D, VascuQol) and individual domain scores using nonparametric tests.

Results: All clinical indicators of lower limb ischemia and quality of life index

scores showed a statistically significant improvement as result of intervention (Friedman test, P < .001). Both generic QOL index scores (SF-6D, EQ-5D) showed moderate but statistically significant correlation (Spearman’s rank correlation, P < .001) with treadmill walking distances (SF-6D r = 0.533, EQ-5D r = 0.500) and weak but significant correlation to resting and postexercise ankle-brachial pressure index (SF-6D r = 0.253, EuroQol r = 0.214). Disease-specific index scores (VascuQol) showed similar moderate correlation to treadmill walking distances (r

= 0.584, P < .001) and weak but statistically Levetiracetam significant correlation with resting and Cyclosporin A datasheet postexercise ABPI (r = 0.377, P < .001). All index scores showed strong and statistically significant (P < .001) correlation with patient-reported walking distance (SF-6D r = 0.604, EQ-5D r = 0.511, VascuQol r = 0.769). All domains of SF36 showed similar correlation with clinical indicators except general health. The strongest correlation was seen with treadmill walking distances in the domains of physical function (r = 0.538) and bodily pain (r = 0.524).

Conclusion: All generic and disease-specific QOL scores show statistically significant improvement with angioplasty and/or supervised exercise in patients with claudication due to femoropopliteal atherosclerosis. However, the degree of improvement seen in clinical indicators of lower limb ischemia is not reflected in these scores. These findings support the use of composite outcome measures with mandatory, independent assessment of QOL as an independent outcome measure in intervention studies in these patients. (J Vase Surg 2010;52:77-84.